Respiratory Distress Syndrome

Respiratory Distress Sequele/Disabil ity

Deat h Early Diagnosis, Quick and Prompt treatment Occurs in 4-6% newborn Many are pre entable

Definition
!espiratory distress due to se eral causes wit" t"e symptom comprises #

Dyspnea $runting %ac"ypnea # *yanotic !! & 6' ()mnt *"est indrawing in room temperature

Causes of Respiratory Distress Pulmonary

*ardiac + *ongenital ,eart Disease , Myocardial dys-unction *./ + 0sp"y(ia, 1* 2leed Metabolic + ,ypoglycemia Medical # M0/, %%., ,MD, Pneumonia , 0sp"y(ia, 0cidosis Medical # Meconeum 0spirattion /yndrome , %ransient %ac"ypnea o- .ewborn , ,yaline Membrane Disease, Pneumonia , 0sp"y(ia, 0cidosis /urgical # Pneumot"ora(, %rac"eo-oesop"ageal -istula, Diap"ragmatic "ernia

In Preterm :
,yaline Membrane Disease Pneumonia %ransient tak"ypnea 0sp"y(ia

In Term :
Meconeum aspiration /yndrome Pneumonia %ransient %ak"ypnea o- .ewborn Mal-ormation 0cidosis Ot"ers

Diagnostic Approach of Respiratory Distress

History Onset o- distress

$estation 0ntenatal steroids Predisposing -actors + P!OM, -e er 0sp"y(ia 0spiration

Examination Onset o- distress

$estation
Mira Yulianti (01-107)

KKA-172

0ntenatal steroids Predisposing -actors + P!OM, -e er 0sp"y(ia 0spiration

Assessment of Respiratory Distress

Score Rate Cyanosis 1 2 60!"0 *"0 None #ith Nee s*$0% $0% &i '2 &i'2 Retraction None (il Se+ere Grunting None (ini)al 'b+ious Air entry Goo Decrease ,ery poor
Chest Examination 0ir entry

0 < 60 None

Mediastinal s"i-t 0d entitious sounds ,yperin-lation ,eart sound

Pre-term - Possi !e etio!ogy

Eary progressi e - !D/ or ,MD Early transient - 0sp"y(ia, Metabolic causes, ,ypotermia

Term Possi !e etio!ogy

Early well looking - %%., Polycyt"emia Early se ere distress - M0/ 3 0sp"y(ia, Mal-ormation 4ate sick wit" "epatomegaly - *ardiac 4ate sick wit" s"ock - 0cidosis $astric aspirate # Shake test, Polymorph count /epsis screen # Septic Work Up *"est 5+ray # absolutely to be done

In"estigation

Sha#e Test %ake a test tube mi( 8 ',7 ml absolute alco"ol

'67 ml gastric aspirate

/"ake -or 97 seconds 0llow to stand 97 minutes

Suspect Surgica! Cause

Ob ious mal-ormation /cap"oid 0bdomen :rot"ing ,istory o- aspiration

Congenita! $a!formation --- Respiratory Distress

%rac"eo - oesop"ageal -istula Diap"ragmatic "ernia 4obar emp"ysema Pierre !obin /yndrome *"oanal atresia

Respiratory Distress Syndrome

KKA-172

Preterm baby Early onset wit"in 6 "rs

Mira Yulianti (01-107)

/upporti e e idence o- 4)/ ratio !adiology e idence

3 967 , or negati e /"ake test

Pathogenesis of RDS
Decreased or abnormal sur-actant 0l eolar collapse 1mpaired gas e(c"ange !espiratory -ailure

Predisposing factor - RDS

Prematurity *aesarean section 0sp"y(ia Maternal diabetes

Protecti"e factor - RDS

P!OM 1;$! /teroids, %!,

Surfactant Deficiency %amniotic f!uid & gastric aspirate '

/"ake test 4ecit"in)/p"ingomyelin ratio P"osp"atidyl glycerol le el

Respiratory Distress $anagement

Monitoring /upporti e #

/peci-ic

1 < -luids Maintain ital sign O(ygen t"erapy !espiratory support

Antenata! corticosteroid /imple t"erapy t"at sa es neonatal li es ===

Preterm labor >4+?4 weeks o- gestation diabetes Dose # 1n@ection Betamethasone Dexamethasone 6 mg 1M e ery 9> "rs, -our doses

irrespecti e o- P!OM, "ypertension and

12 mg 1M e ery >4 "rs, two doses, or 1n@ection

(xygen Therapy 1ndications # A 0ll babies wit" distress A *yanosis A ,ypo(ia

Met"ods # A .asal cat"eter A .asal prongs A Mask A ,ood),ead 2o( A <entilator Mec"anic

I)*) +!uids

A A A

Depend on conditions o- baby # /"ock, De"ydrated B 2irt" weig"t Metabolic Disturbance D 7%, D 9'%, !4, .ormal saline, Mi(ing :luids
Mira Yulianti (01-107)

KKA-172

Dose # depend on body weig"t and day o- li-e *onsider Electrolyte reCuirement

Supporti"e treatment Medication

.utrition or :eeding .ursing care

Medication A 0ntibiotics # i- in-ection de elopes 0mpicilline 8 $entamicin *e-ota(ime , etc Depend on culture and)or *linical signs A /odium bicarbonate, Epinep"rine etc A *alcium $luconate A etc .utrition A 2reast :eeding :irst c"oice $i en as soon as possible regarded to baby condition # gi en oral -eeding Mig"t be gi en to entilated baby A Parenteral .utrion # %otal Parenteral .utrition Partial Parenteral .utrition .ursing + *are A A A A A

stable, possible to be

Darm, dry cot, sur-ace etc 4imited in asi e procedures6 Proper daily care !e"abilitation + P"ysiot"erapy 2lood trans-usion # i- indicated

Specific Condition
$econium Aspiration Syndrome Meconium staining # Antepartum, intrapartum %"in # Chemical pneumonitis %"ick # Atelectasis, airway blockage , airleak syndrome Post term)/:D Meconium staining # cord, nail, skin Onset wit"in 4 to 6 "rs *"est ( ray # Hyperinflated chest Management :

Pre ention by orop"aryngeal suction be-ore deli ery o- s"oulder Electi e E% suction i- baby is depressed and or t"ick meconium O(ygen t"erapy 1< -luids 0ntibiotics i- indicated

Transient Tachypnea of The ,e- orn *aesarean born Delayed clearence o- lung -luid Diagnosis by e(clusion Management supporti e Prognosis $ood Congenita! Pneumonia Predisposing -actors #

KKA-172

P!OM & >4 "rs

Mira Yulianti (01-107)

-oul smelling liCuor peripartal -e er unclean or multiple P)< %reatment # %"ermoneutral en ironment, .il per oral , 1< :luids, O(ygen 0ntibiotics E0mpi 8 $entaF

Pneumothorax Etiology # /pontaneous, M0/ *linical -eatures #

/udden distress 1ndistinct "eart sounds Management # .eedle aspiration *"est tube

RDS : ,eeding Referra!

!D/ E,MDF M0/ /urgical or *ardiac disease PP,. /e ere or worsening distress

KKA-172

Mira Yulianti (01-107)